title: Medical emergencies and cardiopulmonary arrests in interventional radiology.
abstract: OBJECTIVE
  To evaluate the circumstances and determine the outcomes of medical emergencies (MEs) and cardiopulmonary arrests (CPAs) in patients undergoing interventional radiology (IR) procedures.
  
  
  METHODS
  Retrospective review of all MEs and CPAs that occurred between July 2006 and December 2011 was performed. Procedure type, technical outcome, complications, etiology and location of ME/CPA, event outcome, and postevent mortality were collected.
  
  
  RESULTS
  A total of 58 events occurred during 38,927 procedures (0.15%). Complete records were available for 55 events (43 MEs, 12 CPAs) in 53 patients (mean age, 63 y; 58.5% male) during 37 inpatient (27 MEs, 10 CPAs) and 18 outpatient (16 MEs, two CPAs) encounters. Seven events (13%; six MEs, one CPA) occurred before the start of the procedure, and 18 (33%; 16 MEs, two CPAs) occurred in the periprocedural holding area. Thirty-five procedures (64%) were completed successfully. Forty-two patients (76%) were alive at discharge, 37 (67%) at 1 month, 26 (47%) at 3 months, and 23 (42%) at 1 year. Procedural complications were attributed as the main cause of 22 MEs (51%) and one CPA (8%; P = .018). The relative risk (RR) of an ME or CPA occurring during a hemodialysis access case versus all other cases was 5.2 (95% confidence interval = 3.02-8.95; P < .0001).
  
  
  CONCLUSIONS
  Although the incidence of MEs/CPAs in patients undergoing IR procedures is low, the 1-year mortality rate following these events is high. MEs are significantly more likely than CPAs to be directly attributed to a procedural complication. The RR of MEs/CPAs is significantly higher in hemodialysis access interventions.
authors.affiliation: Division of Interventional Radiology and Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania. Electronic address: gregory.nadolski@uphs.upenn.edu.
authors.forename: Gregory
authors.initials: G
authors.lastname: Nadolski
authors.forename: Amy
authors.initials: A
authors.lastname: Praestgaard
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: Cormac
authors.initials: C
authors.lastname: Farrelly
mesh_terms: D016887:Cardiopulmonary Resuscitation; D002404:Catheterization / Q000009:adverse effects; D015897:Comorbidity; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: ASA; American Society of Anesthesiologists; CPA; ICU; IR; ME; PAE; RR; cardiopulmonary arrest; intensive care unit; interventional radiology; medical emergency; pulseless electrical activity; relative risk